Dr Christine Chang1, Dr Shahadat Hossain1
1Queensland Health, Brisbane , Australia
Biography:
Dr Christine Chang is a first year Nephrology Advanced Trainee, currently training at Mater Hospital South Brisbane. She is exploring the different facets of Nephrology and broadening her understanding of the field of Nephrology. This is her first in-person ANZSN ASM!
Background:
Both antineutrophil cytoplasmic antibody (ANCA) and anti-glomerular basement membrane (GBM) disease are rare disease entities. However there is frequent coexistence of both antibodies in patients who present with rapidly progressive renal failure.
Case Report:
We therein report a case of a 67-year-old man who presented to hospital with anuric renal failure and acute pulmonary oedema requiring urgent continuous renal replacement therapy (CRRT) and non-invasive ventilation in Intensive Care Unit. Serum p-ANCA was found positive, as well as positive Anti-GBM antibodies, and subsequent renal biopsy revealed diffuse necrotising glomerulonephritis with 100% cellular crescent along with anti-GBM pattern of disease confirmed on immunofluorescence. This was correlated with high anti-GBM titre in serum. Methylprednisolone pulse and plasma exchange were performed, then subsequently a course of cyclophosphamide was administered. Six months later, patient remains on intermittent haemodiafiltration, without recovery of renal function.
Conclusion:
This case highlights the challenges in treatment response in mixed ANCA and anti-GBM disease with severe crescentic glomerulonephritis.